News briefs and information from Federal agencies and Capitol Hill on government activities, legislation, and grants of interest to the telemedicine, telehealth, and health IT community. Edited by Carolyn Bloch.

Wednesday, February 9, 2011

NC HIE Scheduled for 2011

North Carolina is getting ready to exchange data through the North Carolina Health Information Exchange (NC HIE). Core services initially will provide a foundation for more complex capabilities at a later date that will enable the system to search, locate, and integrate information across multiple systems.

NC HIE does not intend to build duplicate or provide competing HIE services in the state. Instead the focus will be on providing core services such as registries of authenticated exchange partners.

The NC HIE issued an RFP on January 21, 2011 with the proposal due February 4th to find the services of a Consultant/Contractor either an individual or a firm to help NC HIE find vendors to implement the system.

The goals for the state HIE in 2011 in general are to:

• Support legislation to facilitate an “Opt Out Consent Model” and to harmonize various state laws related to medical records• Identify and contract with an IT vendor• Deploy core services representing the suite of registries, record locator services, and security functions• Draft a set of policies and procedures to govern participation in the HIE• Identify and contract with Qualified Organization Pilot sites to utilize the HIE• Develop and secure financing• Recruit more highly competent staff and further develop the non-profit organizational structure• Initiate value-added service development and in the future roll out for more robust service offerings that will be of immediate value to participants• Finalize the Board of Directors bylaws

After a consultant contractor is selected, plans will be made to develop the Request for Proposal for the HIE with the RFP to be released on March 22, 2011. However, vendors have only 18 business days to prepare proposals that are due April 18, 2011.

Plans for the spring are to develop a financing approach, address privacy and security policies, develop the criteria for qualified organizations, review proposals, and negotiate the awarded contract. Later in the summer time framework, work will begin to build the initial HIE services and connect to qualified organizations. Later in the year, plans are to develop and deploy additional services.

The state has been working very hard to refine cost projections and identify additional revenue sources. The initial feedback has suggested that the cost estimate for $24 million over 5 years was too high. As a result, NC HIE will use information received from other states and the RFP process to refine cost calculations.

A Pre-Payment Model has been proposed to help rise the $11 million to cover the estimated minimum $24 million development costs. By raising the money upfront, North Carolina would be able to deploy the full range of HIE services as soon as possible, encourage widespread participation, maximize meaningful use participation, lock in multi-year commitments from a critical mass of constituents, create lock-in of stakeholders, and reduce the administrative burden.

The Pre-Payment Model would include:

• Pre-payments from 6 to 10 of the largest hospital systems of approximately $3.85 million over four years to cover 35 percent of the needed funds• Pre-payments from two or three of the largest commercial payers of approximately $3.85 million over four years to cover 35 percent of funds• The North Carolina Medicaid would use would contribute $2.2 million over four years to cover 20 percent of the needed funds• Providers would make pre-payments from large practices of 100 or more to provide approximately $1.1 million over four years to cover 10 percent of the needed funds

If the state used The Pay As You Go Model with flexibility in payment options, it would be more affordable for smaller stakeholders. However, there are risks involved in using this model. First of all there may be insufficient grant funds to implement advances in the HIE and there would also be lower adoption rates as participants would wait for more compelling functionality and value and this could result in lower revenues. Further financial details and approaches are being studied at this time.

Key research reports:

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